达芬奇机器人胸腺扩大切除术与胸腔镜胸腺扩大切除术的临床疗效对比

A Comparative Study of Clinical Efficacy: Da Vinci Robotic-Assisted versus Video-Assisted Thoracic Surgery for Extended Thymectomy

摘要: 目的：本研究旨在对比达芬奇机器人辅助胸腔镜手术(robot-assisted thoracoscopic surgery, RATS)和电视辅助胸腔镜手术(video-assisted thoracoscopic surgery, VATS)治疗胸腺肿瘤患者的围手术期临床疗效、安全性和可行性。方法：研究收集了2019年4月至2023年10月在烟台毓璜顶医院胸外科接受胸腺扩大切除术的192例胸腺瘤患者，其中RATS组97例(男44例，女53例，平均年龄52.23岁)，VATS组95例(男29例，女66例，平均年龄53.60岁)。对比了两组患者在术中出血量、术后疼痛、住院时间、术后并发症、住院总费用等方面的差异，并对合并重症肌无力(myasthenia gravis, MG)的患者进行亚组分析。结果：1) RATS和VATS两组手术方式均无中转开胸、围手术期死亡病例发生。RATS组相较于VATS组术后住院时间[3 (2, 3)天vs 4 (3, 4)天，P = 0.000]、术后胸管引流时间[2 (2, 2)天 vs 3 (2, 3)天，P = 0.000]、术后止痛药物使用天数[4 (3, 5)天 vs 5 (4, 5)天，P = 0.000]、术后重度疼痛构成比[8.0% vs 20.2%, P = 0.037]、术后轻度疼痛构成比[43.7% vs 17.6%, P = 0.001]、住院总费用[41,105.50 (31,810.10, 47,611.47)元 vs 21,956.42 (9636.01, 28,991.25)元，P = 0.000]、手术时间[95 (80, 115) min vs 90 (70, 110) min, P = 0.046]，差异具有统计学意义。两组之间手术出血量、术后胸管引流总量、术后并发症发生率、术后中度疼痛构成比，P > 0.05，差异均无统计学意义。2) 合并MG的RATS和VATS亚组对比分析，两组术后肌无力缓解率、术后肌无力危象发生率、术后并发症发生率，P > 0.05，差异均无统计学意义。合并MG的RATS亚组住院总费用显著高于合并MG的VATS亚组[37,672.91 (33,073.30, 49,663.26)元 vs 16,268.31 (9642.26, 31,239.10)元，P = 0.043]，差异有统计学意义。结论：RATS和VATS在围手术期的临床疗效与安全性相似，RATS组在术后恢复方面具有明显优势，但其住院费用较高。合并MG的患者，两组在缓解率、并发症发生率等方面差异不大，但RATS组的住院费用显著较高。因此一定程度上影响了其更为广泛的临床应用。

Abstract: Objective: This study aims to compare the perioperative clinical efficacy, safety, and feasibility of robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the treatment of thymic tumors. Methods: A total of 192 patients with thymomas who underwent thymectomy at Yantai Yuhuangding Hospital from April 2019 to October 2023 were included. The RATS group consisted of 97 patients (44 male, 53 female, median age 52.23 years), and the VATS group consisted of 95 patients (29 male, 66 female, median age 53.60 years). Comparisons were made between the two groups regarding intraoperative blood loss, postoperative pain, hospital stay, postoperative complications, total hospitalization costs, and other perioperative indicators. Subgroup analysis was performed for patients with myasthenia gravis (myasthenia gravis, MG). Results: 1) No cases of conversion to open surgery or perioperative mortality occurred in either group. Compared to the VATS group, the RATS group had significantly shorter postoperative hospital stay [3 (2, 3) days vs. 4 (3, 4) days, P = 0.000], shorter chest tube drainage time [2 (2, 2) days vs. 3 (2, 3) days, P = 0.000], fewer days of postoperative pain medication use [4 (3, 5) days vs. 5 (4, 5) days, P = 0.000], lower incidence of severe pain [8.0% vs. 20.2%, P = 0.037], higher incidence of mild pain [43.7% vs. 17.6%, P = 0.001], higher total hospitalization costs [41,105.50 (31,810.10, 47,611.47) CNY vs. 21,956.42 (9636.01, 28,991.25) CNY, P = 0.000], and shorter surgical time [95 (80, 115) min vs. 90 (70, 110) min, P = 0.046]. There were no significant differences between the two groups in terms of intraoperative blood loss, total chest tube drainage, postoperative complications, or moderate pain incidence (P > 0.05). 2) Subgroup analysis of patients with MG showed no significant differences between RATS and VATS in terms of postoperative myasthenia relief rate, myasthenic crisis occurrence rate, or postoperative complications (P > 0.05). The total hospitalization cost for the RATS subgroup with MG was significantly higher than the VATS subgroup [37,672.91 (33,073.30, 49,663.26) CNY vs. 16,268.31 (9642.26, 31,239.10) CNY, P = 0.043]. Conclusion: RATS and VATS have similar perioperative clinical efficacy and safety. RATS has significant advantages in postoperative recovery, but it comes with higher hospitalization costs. In MG patients, there were no significant differences in the myasthenia relief rate or postoperative complications between the two methods, but the hospitalization costs were significantly higher in the RATS group, which limits its broader clinical application.